Provider Demographics
NPI:1861515538
Name:NUVAL, GRACE HERNANDEZ (DMD)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:HERNANDEZ
Last Name:NUVAL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 S KNOTT AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3604
Mailing Address - Country:US
Mailing Address - Phone:714-527-4404
Mailing Address - Fax:714-229-8158
Practice Address - Street 1:910 S KNOTT AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3604
Practice Address - Country:US
Practice Address - Phone:714-527-4404
Practice Address - Fax:714-229-8158
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA341811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice